Radioguided Parathyroid Surgery (MIRP) appears to be changing
the the way endocrinologists are treating patients with
parathyroid disease (hyperparathyroidism). Moreover, the
frequency with which endocrinologists refer patients with
parathyroid disease to a surgeon appears to be increasing
significantly because of the availability of mini-parathyroid
surgery in some areas of the country.
To determine the impact that Minimally Invasive Radioguided
Parathyroid Surgery (MIRP) is having on the way
endocrinologists treat hyperparathyroidism.
The membership of the American Association of Clinical
Endocrinologists was surveyed by mail regarding physician
practices and surgical referral patterns for parathyroid
disease. The survey utilized a visual analog scale
(VAS) and multiple-choice questions. The associations were
tested for statistical significance using Chi-square and logistic
regression. Data are meanąSEM.
The 788 responding endocrinologists had been practicing for an
average of 17 years. They referred an estimated 63% of all
patients with parathyroid overactivity for operative
treatment, and typically utilized parathyroid localizing studies
to surgical referral (Sestamibi scan most commonly).
80% indicated that the availability of mini parathyroid
surgery (MIRP) would (or
has already) increase the number of patients referred for
parathyroid surgery, to near 95% of all of their patients with parathyroid
disease. Endocrinologists identified parathyroid symptoms, calcium
homeostasis, bone density, health status, risk of general
anesthesia, and patient age as the most important factors in
their decision to send their patients for a parathyroid
operation. By far the most important factor in deciding
whether to send a patient for a parathyroid operation was the
availability of an expert parathyroid surgeon, and their
ability to perform a mini-operation.
also indicated that the availability of Minimally Invasive
Radioguided Parathyroid surgery (MIRP) would change the
extent and duration of their preoperative workup of their
parathyroid patients they would send for surgery (p<0.0001). In other words, they overwhelmingly stated that
if their patients could have a mini parathyroid operation
(MIRP) rather than a standard parathyroid operation, they would order fewer tests and send the patient
for an operation much sooner. Younger endocrinologists
were statistically more likely to refer patients for mini
surgery (p=0.001) sooner
and thus alter the extent of the preoperative work-up for
these parathyroid patients (p=0.03).
than 50% of endocrinologists stated that they had one or more
patients who underwent a standard parathyroid operation in the
had a significant complication, or who were not cured by the
operation. These endocrinologists were more anxious to
send their patients for a minimal parathyroid operation
when asked if they had to have a parathyroid operation
themselves, 96.5% of all endocrinologists stated they would
have a Minimally Invasive Radioguided Parathyroidectomy (MIRP) rather than a standard operation (p<0.0000001).
These data confirm the clinical impression seen by the authors
(Dr. Norman, et, al.) that mini parathyroid surgery lowers
most endocrinologist's threshold to refer parathyroid patients for surgery.
Moreover, having mini parathyroid surgery available for their
parathyroid patients is very
likely to decrease the number of tests these doctors order.
The availability of mini parathyroid surgery will also
decrease the time from diagnosis to referral--so the amount of
complications such as osteoporosis will be less.
Because of the perceived shortcomings of traditional
parathyroid surgery, endocrinologists are rapidly embracing
minimally-invasive parathyroid techniques validated by
disciplined outcomes research.